GHRH and pituitary gland adenoma: Primary empty sella syndrome is frequently associated to GH deficiency; [18] thus, the coexistence of this image with acromegaly might be explained by the existence of GH-secreting pituitary microadenomas or an ectopic pituitary adenoma [19–21], or more likely, by an ectopic secretion of GHRH, usually by a bronchial carcinoid tumor [22–24].